Risk scores versus natriuretic peptides for identifying prevalent stage B heart failure

Sachin Gupta, Anand Rohatgi, Colby R. Ayers, Parag C. Patel, Susan A. Matulevicius, Ronald M. Peshock, David W. Markham, James A. De Lemos, Jarett D. Berry, Mark H. Drazner

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Background: Identifying asymptomatic individuals with American Heart Association/American College of Cardiology stage B heart failure (HF) in the population is an important step to prevent the development of symptomatic HF. The comparative utility of 2 screening strategies (biomarkers vs risk scores) in identifying prevalent stage B HF is unknown. Methods: Participants 30 to 65 years old without symptomatic HF in the Dallas Heart Study who had a cardiac magnetic resonance imaging were included (n = 2,277). Stage B HF (n = 284) was defined by left ventricular (LV) hypertrophy, reduced LV ejection fraction, or prior myocardial infarction. We compared the utility of 2 risk scores (Health Aging and Body Composition HF risk score and the Framingham Heart Failure risk score) with B-type natriuretic peptide (BNP) and N-terminal pro-BNP in identifying stage B HF using logistic regression. Results: Depending upon the method of indexing LV mass (body surface area, fat-free mass, or height 2.7), the c-statistic for the Health Aging and Body Composition HF risk score (0.73, 0.75, and 0.64, respectively) was greater than that for BNP (0.62, 0.70, and 0.57, respectively) and N-terminal pro-BNP (0.62, 0.69, and 0.56, respectively) (P < .01 for all). These findings were similar for the Framingham Heart Failure risk score except when LV mass was indexed to fat-free mass. Addition of natriuretic peptide levels to the risk scores resulted in a modest but significant improvement in discrimination of stage B HF (Δ c-statistic, 0.01-0.03, P < .05 for all). Conclusions: Screening for stage B HF in the population is enhanced when natriuretic peptides are measured in addition to, rather than in place of, traditional risk scores.

Original languageEnglish (US)
Pages (from-to)923-930.e2
JournalAmerican heart journal
Issue number5
StatePublished - May 2011

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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